China: Adherence to PrEP among MSM

Qu Dou, Zhong Xiaoni, Xiao Guiyuan, Dai Jianghong, Liang Hao, Huang Ailong.Adherence to Pre-exposure Prophylaxis among Men Who have Sex with Men: A Prospective Cohort Study.International Journal of Infectious Diseases (2018),



To evaluate the adherence to pre-exposure prophylaxis (PrEP) in a clinical trial of a population of men who have sex with men(MSM), to explore the influence of social psychology and objective factors (e.g., forgetting, too busy,) on adherence and to provide evidence for subsequent PrEP research.


Within the PrEP study (a randomized placebo-controlled trial of oral tenofovir and emtricitabine/tenofovir among MSM in Western China from April 2013 to March 2015), we analyzed data from the daily medication group. A total of 331 participants were analyzed. PrEP adherence was self-reported by the subjects at every 3-month follow-up visit for 24 months. AIDS-related information including HIV prevention, transmission and treatment knowledge, as well as PrEP-related motivation (including personal and social motivation) and behavior skills, i.e., self-efficacy, were collected by questionnaires. The objective reasons for non-adherence were collected during face-to-face follow-up visits every three months. A theoretical model of information motivation behavior skills (IMB) was constructed. Then Confirmatory factor analysis was performed to test the fit of each IMB construct. Finally, the structure equation model was used to evaluate the IMB model.


The median adherence rate was 64.29%. During the follow-up period, the percentage of high adherence (adherence ≥ 80%) was 32.33%, intermediate adherence (adherence 40% to 80%) was 38.97% and low adherence (adherence ≤40%) was 28.70%. The final IMB model showed that there was no significant correlation between the adherence to PrEP and the psychological constructs: information, motivation, and behavior skills. The main objective reasons for non-adherence were “forgetting to take medicine” (70.21%), “too busy " (29.08%), ‘worrying about side effects’ (28.01%), and “too much trouble” (18.44%).


In conclusion, there is no association between PrEP adherence and social psychological factors, and the main non-adherenceobjective factor is forgetting to take medicine. In the future, we can remind the MSM population to take their medicine regularly by using electronic devices, which may improve the PrEP adherence to some extent and may further reduce the incidence of HIV. The strategy to improve PrEP adherence requires further study.


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